Credit Application Blanks - ABC-Amega, Inc.

SAMPLE CREDIT APPLICATION

COMPANY NAME: _________________________________________________

PHONE: _______________________

STREET ADDRESS: _______________________________________________

FAX: __________________________

CITY: _______________________________________ STATE: ____________

ZIP: ___________________________

BILLING ADDRESS (IF DIFFERENT FROM ABOVE): _____________________________________________________

CITY: ______________________________________

STATE: ____________

EMAIL: _____________________________________

CREDIT LINE SOUGHT: _______________________________

COMPANY IS A:

CORPORATION

PARTNERSHIP

ZIP: __________________________

PROPRIETORSHIP

L.L.C.

P.L.C.

CORPORATE REGISTRATION NO. _______________ V.A.T. NO. ___________ ANNUAL SALES ________________

ARE FINANCIAL STATEMENTS AVAILABLE?

YES

NO

# YEARS IN BUSINESS __________________

NOTE: IF IN BUSINESS LESS THAN FIVE YEARS, YOU MUST COMPLETE PERSONAL GUARANTEE

COMPANY DIRECTORS/OFFICERS/PRINCIPAL

NAME 1: __________________________________________________________ TITLE: ________________________

HOME ADDRESS: __________________________________________________ PHONE: _______________________

NAME 2: __________________________________________________________ TITLE: ________________________

HOME ADDRESS: __________________________________________________ PHONE: _______________________

NAME 3: __________________________________________________________ TITLE: ________________________

HOME ADDRESS: __________________________________________________ PHONE: _______________________

BANKING DETAILS

BANK NAME: _____________________________________________________ ACCOUNT #: ___________________

BRANCH ADDRESS: __________________________ CITY/STATE/ZIP: _____________________________________

BANK CONTACT NAME: ____________________________________________ PHONE: _______________________

TRADE REFERENCES

VENDOR 1: __________________________________ CONTACT: __________________________________________

PAYMENT ADDRESS: _________________________ CITY/STATE/ZIP: _____________________________________

PHONE: _____________________________________ FAX: ________________ ACCOUNT #: ___________________

VENDOR 2: __________________________________ CONTACT: __________________________________________

PAYMENT ADDRESS: _________________________ CITY/STATE/ZIP: _____________________________________

PHONE: _____________________________________ FAX: ________________ ACCOUNT #: ___________________

VENDOR 3: __________________________________ CONTACT: __________________________________________

PAYMENT ADDRESS: _________________________ CITY/STATE/ZIP: _____________________________________

PHONE: _____________________________________ FAX: ________________ ACCOUNT #: ___________________

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CONDITIONS (TERMS ARE NET 30 DAYS UPON CREDIT APPROVAL)

TERMS OF SALE, INCLUDING TERMS OF PAYMENT AND CHARGES, FOR EACH PURCHASE ARE AGREED TO BE THOSE

SPECIFIED ON THE FACE OF EACH INVOICE. THE CUSTOMER HEREBY AGREES TO PAY ALL COSTS OF COLLECTION OR

LEGAL FEES SHOULD SUCH ACTION BE NECESSARY DUE TO NON-PAYMENT. THE ABOVE INFORMATION IS WILLINGLY

SUPPLIED AND THE CREDITOR IS AUTHORIZED TO CONTACT THE ABOVE BANK AND TRADE REFERENCES IN ORDER TO

ESTABLISH THE CREDITWORTHINESS OF THE ABOVE NAMED COMPANY. IF THE APPLICANT IS NOT A CORPORATION,

THE CREDITOR IS AUTHORIZED TO OBTAIN CREDIT REPORTS ON THE PROPRIETORS, PARTNERS OR PRINCIPALS.

SHOULD A CREDIT AVAILABILITY BE GRANTED BY THE CREDITOR, ALL DECISIONS WITH RESPECT TO THE EXTENSION

OR CONTINUATION SHALL BE IN THE SOLE DISCRETION OF THE CREDITOR. THE CREDITOR MAY TERMINATE ANY CREDIT

AVAILABILITY WITHIN ITS SOLE DISCRETION.

DISPUTES: ANY DISPUTE OR CONTROVERSY ARISING FROM THIS AGREEMENT WILL BE RESOLVED BY ARBITRATION BY

THE AMERICAN ARBITRATION ASSOCIATION AT ORANGE COUNTY, CALIFORNIA. THE LANGUAGE OF THE ARBITRATION

SHALL BE ENGLISH. THE NUMBER OF ARBITRATORS SHALL BE ONE. THE PARTIES AGREE THE AMERICAN ARBITRATION

ASSOCIATION¡¯S EXPEDITED RULES SHALL APPLY AND THEY WAIVE ALL RIGHT TO ANY HEARING REQUIRING WITNESS

PRODUCTION. THE ARBITRATOR SHALL ISSUE AN AWARD BASED UPON THE WRITTEN DOCUMENTARY EVIDENCE

SUPPLIED BY THE PARTIES. THE ARBITRATOR¡¯S AWARD SHALL BE BINDING AND FINAL. THE LOSING PARTY SHALL PAY

ALL ARBITRATION EXPENSES, INCLUDING ALL ATTORNEY¡¯S FEES.

I HAVE READ AND UNDERSTAND THE ABOVE TERMS AND CONDITIONS, AND HEREBY AGREE TO THEM:

APPLICANT¡¯S NAME: ______________________________________ TITLE: ________________________________

DATE: ______________________________________ APPLICANT¡¯S SIGNATURE: ___________________________

FOR PROPRIETORS, PARTNERS, S-CORPORATIONS IN THE U.S.

I AUTHORIZE THE SELLER AND THEIR ASSIGNS TO OBTAIN A CONSUMER CREDIT REPORT ON MY CREDIT HISTORY.

DATE: ______________________________________ APPLICANT¡¯S SIGNATURE: ____________________________

PERSONAL GUARANTEE

THE UNDERSIGNED, FOR CONSIDERATION DO HEREBY INDIVIDUALLY AND PERSONALLY GUARANTEE THE FULL AND

PROMPT PAYMENT OF ALL INDEBTEDNESS HERETOFORE OR HEREAFTER INCURRED BY THE ABOVE BUSINESS. THIS

GUARANTEE SHALL NOT BE AFFECTED BY THE AMOUNT OF CREDIT EXTENDED OR ANY CHANGE IN THE FORM OF SAID

INDEBTEDNESS. NOTICE OF THE ACCEPTANCE OF THIS GUARANTEE, EXTENSION OF CREDIT, MODIFICATION IN TERMS

OF PAYMENT, AND ANY RIGHT OR DEMAND TO PROCEED AGAINST THE PRINCIPAL DEBTOR IS HEREBY WAIVED. THIS

GUARANTEE MAY ONLY BE REVOKED BY WRITTEN NOTICE WHICH SHALL BE SENT TO THE CREDITOR¡¯S CREDIT OFFICE

BY CERTIFIED MAIL. ANY REVOCATION DOES NOT REVOKE THE OBLIGATION OF THE GUARANTORS TO PROVIDE

PAYMENT FOR INDEBTEDNESS INCURRED PRIOR TO THE REVOCATION. I AUTHORIZE THE SELLER AND THEIR ASSIGNS

TO OBTAIN A CONSUMER CREDIT REPORT AND TO CONTACT MY REFERENCES AS NECESSARY. AS GUARANTOR, I AM

ALSO BOUND BY THE ABOVE ARBITRATION CLAUSE.

GUARANTOR¡¯S NAME: _____________________________________

SIGNATURE: __________________________

HOME ADDRESS: _____________________________ CITY/STATE/ZIP: ____________________________________

DATE: _______________________________________ TAX I.D. OR S.S. NO: _________________________________

GUARANTOR¡¯S NAME: _____________________________________

SIGNATURE: __________________________

HOME ADDRESS: _____________________________ CITY/STATE/ZIP: ____________________________________

DATE: _______________________________________ TAX I.D. OR S.S. NO: _________________________________

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